Dr. Bruno Rasmussen Chaves M.D. Dr. Cleuza CananPsychologist Ibogaine Treatment Facility M.P.P. Gonçalves Hospital Santa Cruz do Rio Pardo, São Paulo, Brazil
In Brazil we have been doing treatments with Ibogaine since 1997, in order to treat drug addiction, with excellent results.
Brazil has a huge public health problem with crack/cocaine users, which reaches the number of 2-4% of the population, (190 million), and a small (until nowadays) problem with heroin (~ 50 cases) PROAD (Drug Addicts Orientation and Care Program, Federal University of São Paulo, 2006)
We have treated until February 2009 -54 patients (51 males, 3 females); -from 22 to 49 years old; -53 of these from crack/cocaine addiction; -one from opiates addiction.
Here we will discuss the clinical procedures related to the treatment itself, it's safety, and not the aftercare outcome, although we could not talk about Ibogaine and not say that it is very effective in attenuating the dependence and in stabilizing the life of the majority of the persons who takes it.
All patients seeking to be treated are evaluated by the psychologist, then by the clinician, and asked to perform some basic blood tests (hemogram, liver enzymes, creatinine, sodium, potassium, magnesium, and sugar blood test) and an EKG.
Patients presenting with any of the following conditions are excluded: -pregnancy -significant clinical issues, like non controlled arterial hypertension, non-controlled diabetes, previous myocardial infarction, cardiac arrhythmias, renal failure, hepatic failure, Alzheimer and Parkinson diseases. Exclusion Criteria
Psychiatric diseases -Schizofrenia -Anti-social personality Social issues -Living alone subject -subject who has not a proper social and professional environment to come back to Exclusion Criteria
After this evaluation, the treatment is scheduled, and is asked for the patient that he/she stays abstinent from crack/cocaine for at least 20 days. The patient may be hospitalized if he/she feels that he/she could not achieve this goal alone, at home.
In the day before the treatment the patient is asked to eat light food in the evening, and to drink a lot of water until midnight. After that, he is asked not to eat or drink anymore.
In the day of the procedure the patient arrives at the hospital at 7 o’clock, he/she takes 20 mg of domperidone, and after 30 minutes he takes 12-20 mg/kg of Ibogaine HCL. Although domperidone is described as a drug that has a possible risk of inducing a Torsades de Points arrhythmia, we have never seen it. All the time the subject is monitorized, which includes cardiac monitorization, blood pressure measures, and oxymetric monytorization.
The average patient throws up a few times, some few a little more, he shows ataxia, tremors and visualizations, but there was no significant clinical occurrences during this number of procedures, except for:
-one patient (male, 25 ) that had a drop in the cardiac frequency to 45 bpm, with the EKG showing sinusal bradycardia, which lasted for 3 minutes, without hemodinamic repercussions or symptoms.
-Another patient (male, 30) that had thrown up several times, and presented with an upper gastrointestinal bleeding, probably a Mallory-Weiss syndrome, (where the repeated vomiting causes a rupture of the mucosae of the terminal esophagus and bleeding). This patient had not any hemodinamic repercussions, performed an upper gastrointestinal endoscopy which confirmed the Mallory Weiss syndrome and was discharged 2 days later in a very good condition.
It´s interesting to say that one patient, (male, 38), had a history of being shot by a firegun, years before the treatment, and had 2 bullets still on his body, one near the heart, and another located at the T 10 vertebrae, he was performed a parcial pancreatectomy, a left pneumectomy, a left nefrectomy and a splenectomy. Although all this procedures, he was in a good health situation, and was treated, with absolutely no intercurrences.
In all of this 54 cases treated, absolutely no complications were seen, what makes us conclude that the treatment with Ibogaine seems to be a safe procedure.
It is very important to follow a rigorous clinical protocol and to be aware of pre-treatment clinical conditions, mainly cardiac problems. It is important to the patient to be rested, well hydrated, in good clinical conditions. Conclusion
Sedation We strongly recommend not to sedate the patient, shortly after the treatment, in order to the subject fully feel ibogaine effects. But when it is necessary, we use diazepam.